title: Patient safety in the context of neonatal intensive care: research and educational opportunities.
abstract: Case reports and observational studies continue to report adverse events from medical errors. However, despite considerable attention to patient safety in the popular media, this topic is not a regular component of medical education, and much research needs to be carried out to understand the causes, consequences, and prevention of healthcare-related adverse events during neonatal intensive care. To address the knowledge gaps and to formulate a research and educational agenda in neonatology, the Eunice Kennedy Shriver National Institute of Child Health and Human Development invited a panel of experts to a workshop in August 2010. Patient safety issues discussed were the reasons for errors, including systems design, working conditions, and worker fatigue; a need to develop a "culture" of patient safety; the role of electronic medical records, information technology, and simulators in reducing errors; error disclosure practices; medicolegal concerns; and educational needs. Specific neonatology-related topics discussed were errors during resuscitation, mechanical ventilation, and performance of invasive procedures; medication errors including those associated with milk feedings; diagnostic errors; and misidentification of patients. This article provides an executive summary of the workshop.
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20952, USA. rajut@mail.nih.gov
authors.forename: Tonse N K
authors.initials: TN
authors.lastname: Raju
authors.forename: Gautham
authors.initials: G
authors.lastname: Suresh
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D035843:Biomedical Research; D004502:Education, Medical, Continuing; D004869:Equipment Safety; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000331:legislation & jurisprudence / Q000458:organization & administration; D015931:Intensive Care, Neonatal / Q000331:legislation & jurisprudence / Q000458:organization & administration; D008318:Malpractice; D019300:Medical Errors / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D009359:Neonatology / Q000193:education / Q000331:legislation & jurisprudence / Q000458:organization & administration; D009937:Organizational Objectives; D016730:Program Development; D011787:Quality of Health Care; D017751:Safety Management / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014342:Truth Disclosure; D014481:United States